1Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, 2Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, 3Department of Otolaryngology, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea

Received September 19, 2017; Revised October 8, 2017; Accepted October 17, 2017.

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Abstract

Background: Although combined chemotherapy has increased survival rates among children with cancer, such treatments can induce sensorineural hearing loss. Therefore, we aimed to identify risk factors for hearing impairments in patients with childhood cancer. Methods: Audiograms were obtained from 115 patients with childhood cancer and survivors (age ＜20 years). Pure tone audiometry (PTA) was performed at octave intervals within the range of 250-8000 Hz. We evaluated clinical risk factors associated with hearing impairments. Hearing loss was evaluated based on the maximal decibel (dB) loss in any frequency for each ear (RAmax or LAmax) and weighted mean dB loss for specific frequencies (RAavg or LAavg). Results: Forty percent of patients (N=46) exhibited hearing loss ＞20 dB based on the weighted mean value in either ear. Severe hearing impairments were observed in 56% of patients with brain tumors. Although cisplatin or vinca alkaloids were significant risk factors for hearing impairment, the use of both cisplatin and vinca alkaloids exhibited the highest odds ratio for hearing impairment (P＜0.001, ＜0.001 for R/LAmax; P=0.099, 0.039 for R/LAavg). Multivariate analysis revealed that the use of both cisplatin and vinca alkaloids was an independent risk factor for hearing impairment based on RAmax, LAmax, and LAavg (P＜0.001, ＜0.001, 0.039, respectively). Conclusion: Our findings indicate that cisplatin and vinca alkaloids exert an additive effect on the risk of hearing impairment in survivors of childhood cancer. Further prospective studies are thus required to determine the most effective chemotherapeutic regimen for reducing ototoxicity.